eNursing Care Plan 61-1

Patient With a Fracture

Nursing Diagnosis*
Impaired physical mobility related to loss of integrity of bone, movement of bone fragments,
soft tissue injury, and prescribed movement restrictions as evidenced by limited joint range of
motion, inability to purposefully move, and inability to bear weight

Patient Goals
1. Experiences uncomplicated bone healing and return of skeletal function
2. Uses assistive devices as needed to increase physical mobility
3. Experiences no complications of immobility
Outcomes (NOC) Interventions (NIC) and Rationales
Bone Healing Splinting
Intact peripheral circulation Apply splint in position injured body part is found, using
_____ hands to support injury site, minimizing movement, and
Return of skeletal function _____ using the assistance of another health care team
member when possible to avoid fracture displacement
Measurement Scale and soft tissue injury.
1 = None Minimize movement of patient, especially injured body
2 = Limited part to avoid additional injury.
3 = Moderate
4 = Substantial
Monitor for bleeding at injury site to plan appropriate
5 = Extensive intervention.
Monitor circulation (e.g., pulse, capillary refill, and
Pain _____ sensation) in injured body part to detect possible nerve
Edema _____ or vascular damage.
Infection in surrounding tissue Identify most appropriate splint material (e.g., rigid, soft,
_____ anatomical, or traction)
Infection in bone _____
Traction/Immobilization Care
Measurement Scale Position in proper body alignment to enhance traction
1 = Extensive and skeletal function.
2 = Substantial Maintain traction at all times to prevent misalignment of
3 = Moderate bone fragments.
4 = Limited
Monitor circulation, movement, and sensation of
5 = None
affected extremity to detect complications of peripheral
Mobility vascular and nerve function.
Balance _____ Provide trapeze for movement in bed to reduce
Coordination _____ complications of immobility.
Joint movement _____ Monitor skin and body prominences to identify signs of
Moves with ease _____ skin breakdown.
Administer appropriate skin care at friction points to
Measurement Scale prevent skin breakdown.
1 = Severely compromised
2 = Substantially compromised Cast Care: Wet
3 = Moderately compromised Handle the casted extremity with palms only until the
4 = Mildly compromised cast is dry to avoid causing finger indentations that can
5 = Not compromised lead to pressure sores.
Support cast with pillows during the drying period
(avoid pillow under heel) to prevent denting and
flattening of the cast.
Protect the cast if close to groin to prevent soiling of
cast.
Mark the circumference of any drainage to identify
additional drainage during future assessments.
Elevate casted extremity at or above heart level to
reduce swelling or inflammation, as indicated.
Nursing Diagnosis
Risk for peripheral neurovascular dysfunction related to vascular insufficiency and nerve
compression secondary to edema and/or mechanical compression by traction, splints, or casts

Patient Goal
Experiences no peripheral neurovascular dysfunction
Outcomes (NOC) Interventions (NIC) and Rationales
Tissue Perfusion: Peripheral Circulatory Precautions
Localized extremity pain _____ Perform a comprehensive assessment of peripheral
Numbness _____ circulation (e.g., check peripheral pulses, edema,
Tingling _____ capillary refill, color, temperature of extremity) to
Pallor _____ monitor for diminished tissue perfusion and compare to
Paresthesia _____ noninvolved extremity to plan appropriate intervention.
Peripheral edema _____ Prevent infection in wounds to avoid further edema and
Muscle weakness _____ inflammation, which may contribute to additional
vascular insufficiency and nerve compression.
Measurement Scale Maintain adequate hydration to prevent increased blood
1 = Severe
viscosity and blood clots.
2 = Substantial
3 = Moderate
4 = Mild Positioning
5 = None Immobilize or support affected body part to prevent
pressure and injury.
Maintain position and integrity of traction to prevent
compression of blood vessels and nerves.
Elevate affected limb 20 degrees or greater above the
level of heart to reduce edema by promoting venous
return. (Note: If compartment syndrome is suspected,
elevate extremity no higher than heart level.)

Peripheral Sensation Management

Monitor for paresthesia (numbness, tingling,
hyperesthesia, hypoesthesia, and level of pain) to
identify possible nerve compression.
Monitor sharp/dull and/or hot/cold discrimination to
ensure early recognition of and intervention for
compromised circulation or nerve compression.

Nursing Diagnosis
Acute pain related to edema, movement of bone fragments, and muscle spasm as evidenced by
pain descriptors, guarding, crying

Patient Goal
Reports satisfaction with pain management measures
Outcomes (NOC) Interventions (NIC) and Rationales
Pain Control
Uses preventive measures _____
Uses nonanalgesic relief measures
_____
Uses analgesics as recommended
_____
Reports uncontrolled symptoms to
health professional _____
Reports pain controlled _____
Measurement Scale
1 = Never demonstrated
2 = Rarely demonstrated
3 = Sometimes demonstrated
4 = Often demonstrated
5 = Consistently demonstrated
Pain Management
Perform a comprehensive assessment of pain to include
location, characteristics, onset/duration, intensity/
severity of pain, and precipitating factors to plan
appropriate interventions.
Provide patient optimal pain relief with prescribed
analgesics to promote adequate rest and healing.
Notify surgeon if pain-relief measures are unsuccessful
or if current complaint is a significant change from
patient’s past experience of pain to identify impending
compartment syndrome.
Teach the use of nonpharmacologic techniques (e.g.,
relaxation, guided imagery, hot/cold application, and
massage) before, after, and—if possible—during
painful activities; before pain occurs or increases; and
along with other pain relief measures to reduce edema
and promote comfort.
Nursing Diagnosis
Readiness for enhanced health management as evidenced by questions about long-term effect
of immobilization, devices, activity restrictions, and expression of desire to prevent
complications and return to prior health

Patient Goals
1. Describes prescribed activities and their rationales
2. Performs activities as prescribed.
Outcomes (NOC) Interventions (NIC) and Rationales
Knowledge: Prescribed Activity Teaching: Prescribed Exercise
Prescribed activity _____
Purpose of prescribed activity _____
Expected effects of prescribed activity
_______
Prescribed activity restrictions _____
Strategies to gradually increase
prescribed activity _____
Proper performance of prescribed
activity _____
Measurement Scale
1 = No knowledge
2 = Limited knowledge
3 = Moderate knowledge
4 = Substantial knowledge
5 = Extensive knowledge
Compliance Behavior
Discusses prescribed treatment
regimen with health professional
_____
Performs treatment regimen as
prescribed _____
Monitors treatment response _____
Modifies treatment regimen as
directed by health professional _____ hair dryer) to decrease itching.
Measurement Scale
1 = Never demonstrated
2 = Rarely demonstrated
3 = Sometimes demonstrated
4 = Often demonstrated
5 = Consistently demonstrated
Inform the patient of the purpose for and benefits of
the prescribed exercise to promote patient
adherence to exercise regimen.
Instruct the patient how to perform the prescribed
exercise to optimize benefit of activity in
rehabilitation.
Observe the patient perform the prescribed exercise
to evaluate performance and reinforce the activity.
Assist the patient in setting goals for slow, steady
increase in exercise to build strength and optimize
recovery.
Teaching: Psychomotor Skill
Provide written information/diagrams to use as
continued reference at home.
Provide frequent feedback to patients on what they
are doing correctly and incorrectly to avoid
formation of bad habits.
Cast Care: Maintenance
Instruct patient not to scratch skin under the cast
with any objects to prevent skin injury and
infection.
Offer alternatives to scratching (e.g., cold air from
Position cast on pillows to lessen strain on other
body parts with cast heel off pillow.
Pad rough cast edges and traction connections to
prevent skin irritation and breakdown of cast.
Apply ice for first 24-36 hours to reduce swelling or
inflammation.
Address pain and symptoms of compromised
circulation immediately (e.g., reposition cast,
perform range of motion to extremity, immediate
cast pressure-relieving action) to promote
circulation and prevent complications.
eNursing Care Plan 62-2
Patient Having Orthopedic Surgery*
Nursing Diagnosis†
Impaired physical mobility related to pain, stiffness, and physical deconditioning as evidenced
by limited joint movement, difficulty ambulating, inability to participate in physical
rehabilitation, guarded movement
Patient Goals
1. Participates in exercise therapy to increase joint mobility
2. Demonstrates ability to transfer, walk with assistive devices, and move with ease
Outcomes (NOC)
Mobility
Coordination _____
Joint movement _____
Transfer performance _____
Moves with ease _____
Ambulation
Bears weight _____
Walks with effective gait _____
Walks at slow pace _____
Walks at moderate pace _____
Walks moderate distance (>1 block
to <5 blocks) _____
Adjusts to different surface textures
_____
Measurement Scale
1 = Severely compromised
2 = Substantially compromised
3 = Moderately compromised
4 = Mildly compromised
5 = Not compromised
Nursing Diagnosis
Interventions (NIC) and Rationales
Exercise Therapy: Joint Mobility
Determine limitations of joint movement and effect
on function to plan appropriate interventions.
Assist patient to optimal body position for passive/
active joint movement to prevent dislocation or
other complications.
Initiate pain control measures before beginning joint
exercise to decrease discomfort from exercise and
increase patient participation.
Perform passive or assisted ROM exercises to
maintain/improve joint mobility.
Collaborate with physical therapist in developing and
executing an exercise program to increase patient
adherence and promote continuity of exercise.
Exercise Therapy: Ambulation
Assist patient to sit on side of bed to facilitate
postural adjustments.
Apply/provide assistive device (cane, walker, or
wheelchair) for ambulation, if the patient is unsteady
to prevent falls.
Assist patient to stand and ambulate specified distance
and with specified number of staff to safely meet
mobility goals.
Assist patient with initial ambulation and as needed to
promote mobility according to patient’s abilities.
Consult physical therapist about ambulation plan to
reinforce plan and provide unified approach to
patient mobilization.
Acute pain related to tissue trauma, disruption of skin integrity, and edema as evidenced by
reluctance to move, guarding of affected area, persistent score of >8 on a pain scale of 0 to 10,
and/or facial grimacing
Patient Goal
Reports satisfactory relief of pain
Outcomes (NOC)
Pain Control
Uses nonanalgesic relief measures
_____
Uses analgesics as recommended
_____
Reports uncontrolled symptoms to
health care professional _____
Reports pain controlled _____
Measurement Scale
1 = Never demonstrated
2 = Rarely demonstrated
3 = Sometimes demonstrated
4 = Often demonstrated
5 = Consistently demonstrated
Interventions (NIC) and Rationales
Pain Management
Encourage patient to monitor own pain and intervene
appropriately to increase patient’s control over pain
management.
Implement use of patient-controlled analgesia
(PCA), if appropriate, to give patient control over
pain management.
Medicate before an activity to increase ability to
participate but evaluate hazard of sedation.
Evaluate effectiveness of pain control measures
through ongoing assessment of pain experience to
ensure pain management facilitates the healing
process.
Positioning
Position in proper body alignment to reduce pressure
on nerves and tissues.
Nursing Diagnosis
Risk for peripheral neurovascular dysfunction‡ related to edema, circulatory stasis,
dislocated prosthesis, and/or fixation devices

Nursing Diagnosis
Deficient knowledge related to lack of information and resources for follow-up care as
evidenced by expression of concern with ability to care for self after discharge, frequent
questioning about follow-up care, and lack of plan for follow-up care

Patient Goals
1. Describes activities related to treatments, activities of daily living, and obtaining assistance if
needed
2. Verbalizes confidence in ability to follow prescribed discharge plan
Outcomes (NOC)
Discharge Readiness:
Independent Living
Obtains needed assistance _____
Describes prescribed treatments
_____
Describes risks for complications
_____
Manages own medications _____
Performs activities of daily living
(ADLs) independently _____
Measurement Scale
1 = Never demonstrated
2 = Rarely demonstrated
3 = Sometimes demonstrated
4 = Often demonstrated
5 = Consistently demonstrated
ROM, Range of motion.
Interventions (NIC) and Rationales
Discharge Planning
Communicate patient’s discharge plans (e.g., activity
limitations, medications, follow-up visit, signs of
infection, dislocation) to patient and caregiver(s) to
prepare for self-care and decision making.
Collaborate with the physician, patient,
caregiver(s),family member(s), and significant
other(s), and other health care team members to allow
continuity of health care at home or at next level of
care.
Assist patient, caregiver(s), family, and significant
other(s) in planning for the supportive environment
necessary to provide the patient’s post-hospital care.
Consider and coordinate referrals to other health care
professionals to help monitor long-term rehabilitation
program at home.

‡See NCP 62-1 for outcomes and interventions for nursing diagnosis of risk for peripheral
neurovascular dysfunction.